Perioperative Outcomes Following Surgical Treatment of the Neuromuscular Hip: An Analysis of the National Surgical Quality Improvement Program—Pediatrics

Background: Surgical treatment for neuromuscular (NM) hip subluxation or dislocation is undertaken to maintain functionality and decrease pain. Longterm complications are well described;however, the acute complication profile is poorly understood. Questions/Purpose: The aim of this study was to identify the rate of and risk factors for complications following surgical treatment of hip subluxation/dislocation, especially as it relate to NM children. Methods: Hip reconstruction cases in patients with a NM diagnosis and non-NM patients were obtained from the 2015 American College of Surgeons NSQIP-Pediatric database by CPT code. 30-day postoperative complications were classified according to the Clavien-Dindo system as minor (grade 1 or 2) or major (grade 3+). Patient and surgical factors were assessed in univariate and multivariate logistic regression analyses for association with post-operative complications. Results: 1081 cases were identified (median age 7.7, 55% female), of whom 420 (39%) had a NM diagnosis. Overall complication rate was significantly higher in NM patients (33% vs. 19%, p < 0.001). Numerous factors were associated with postoperative complication on univariate analysis. Multivariate analysis identified NM diagnosis (OR 1.5), age > 6 years (OR 1.5), or pelvic osteotomy (OR 1.9) as independent risk factors for complication. Conclusion: In pediatric reconstructive hip surgery requiring pelvic osteotomy, a NM diagnosis is associated with an increased risk of 30-day postoperative complications. Older age and increasing surgical complexity were also independently associated with complications. These findings support special attention for the older patients undergoing concomitant pelvic osteotomies to minimize complication rate.

Spinal fusion is an aerosol generating procedure

BACKGROUND Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures.Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons.Aerosolized particles containing infectious coronavirus are typically 0.5-8.0μm.AIM To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer(OPS).METHODS We quantified airborne particle counts during five posterior spinal instrumentation and fusions(9/22/2020-10/15/2020)using an OPS near the surgical field.Data were analyzed by 3 particle size groups:0.3-0.5μm/m^(3),1.0-5.0μm/m^(3),and 10.0μm/m^(3).We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress.A spike was defined as a>3 standard deviation increase from average baseline levels.RESULTS Upon univariate analysis,bovie(P<0.0001),high speed pneumatic burring(P=0.009),and ultrasonic bone scalpel(P=0.002)were associated with increased 0.3-0.5μm/m^(3)particle counts relative to baseline.Bovie(P<0.0001)and burring(P<0.0001)were also associated with increased 1-5μm/m^(3)and 10μm/m^(3)particle counts.Pedicle drilling was not associated with increased particle counts in any of the size ranges measured.Our logistic regression model demonstrated that bovie(OR=10.2,P<0.001),burring(OR=10.9,P<0.001),and bone scalpel(OR=5.9,P<0.001)had higher odds of a spike in 0.3-0.5μm/m^(3)particle counts.Bovie(OR=2.6,P<0.001),burring(OR=5.8,P<0.001),and bone scalpel(OR=4.3,P=0.005)had higher odds of a spike in 1-5μm/m^(3)particle counts.Bovie(OR=0.3,P<0.001)and drilling(OR=0.2,P=0.011)had significantly lower odds of a spike in 10μm/m^(3)particle counts relative to baseline.CONCLUSION Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range.Further research is warranted to determine if such particles have the potential to contain infectious viruses.Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.

Factors associated with subsequent surgery after septic arthritis of the knee in children

BACKGROUND Septic arthritis of the knee in children is a challenging problem.Surgical debridement is an established treatment,but there is a paucity of literature on long-term prognosis.AIM To determine the rates and factors associated with return to surgery(RTS)and readmission after index surgical debridement for septic arthritis of the knee in children.METHODS This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project(HCUP).We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017.Demographic data included age,gender,race,hospital type and insurance type.Clinical data including index admission length of stay(LOS)and Charlson Comorbidity Index(CCI)were available from the HCUP database.Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.RESULTS Nine-hundred thirty-two cases of pediatric septic knee were included.This cohort was 62.3%male,with mean age of 9.0(±6.1)years.Approximately 46%of patients were white and approximately half had Medicaid insurance.Thirty-six patients(3.6%)required RTS at a minimum of 2 year after index surgery,and 172 patients(18.5%)were readmitted at any point.The mean readmission LOS was 11.6(±11.3)d.Higher CCI was associated with RTS(P=0.041).There were no significant associations in age,gender,race,insurance type,or type of hospital to which patients presented.Multivariate analysis showed that both increased CCI(P=0.008)and shorter LOS(P=0.019)were predictive of RTS.CONCLUSION Septic arthritis of the knee is an important condition in children.The CCI was associated with RTS at a minimum of 2 years after index procedure.No association was found with age,gender,race,insurance type,or hospital type.Shorter LOS and CCI were associated with RTS in multivariate analysis.Overall,risk of subsequent surgery and readmission after pediatric septic knee arthritis is low,and CCI and shorter LOS are predictive of RTS.

Effect of acupuncture on inflammatory cytokines expression of spastic cerebral palsy rats

Objective:To To investigate the effect of acupuncture on the tumor necrosis factor- α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),nitric oxide synthase(NOS) content and muscular tension of spasticity cerebral palsy rat model.Methods:The rats with spastic cerebral palsy were randomly divided into the control group,model group and acupuncture group.After successful modeling,the muscular tension and the content of TNF- α,IL-6,CRP.NOS were measured.Results:The serum TNF- α,IL—6,CRP,NOS content were significantly decreased in the acupuncture group(P<0.05).The low and high shear viscosity of whole blood of the acupuncture group were significantly lower than the control group and the model group(P<0.05).The erythrocyte electrophoresis indexes in the acupuncture group were significantly lower than that in the model group and the control group(P<0.05).Acupuncture significantly reduced the muscular tension of spastic cerebral palsy rat and increased the active extent in the paralytie extremity(P<0.05),but it could not be restored to normal level.Compared with the control group,the difference had significant(P<0.05).Conclusions:Acupuncture treatment can inhibit the release of inflammatory cells after brain injury,then reduce immune injury,relieve muscle spasms and reduce muscular tension.

Osteogenesis of Adipose-Derived Stem Cells

Current treatment options for skeletal repair, including immobilization, rigid fixation, alloplastic materials and bone grafts, have significant limitations. Bone tissue engineering offers a promising method for the repair of bone deficieny caused by fractures, bone loss and tumors. The use of adipose derived stem cells （ASCs） has received attention because of the self-renewal ability, high proliferative capacity and potential of osteogenic differentiation in vitro and in vivo studies of bone regeneration. Although cell therapies using ASCs are widely promising in various clinical fields, no large human clinical trials exist for bone tissue engineering. The aim of this review is to introduce how they are harvested, examine the characterization of ASCs, to review the mechanisms of osteogenic differentiation, to analyze the effect of mechanical and chemical stimuli on ASC osteodifferentiation, to summarize the current knowledge about usage of ASC in vivo studies and clinical trials, and finally to conclude with a general summary of the field and comments on its future direction.

Multilineage Differentiation of Dental Pulp Stem Cells from Green Fluorescent Protein Transgenic Mice

Aim The aim of this study was to confirm the multilineage differentiation ability of dental pulp stem cells （DPSCs） from green fluorescent protein （GFP） transgenic mice. The expression of GFP in DPSCs was also observed during differentiation. Methodology DPSCs were harvested from the dental pulp tissue of transgenic nude mice, and then transferred to osteogenic, adipogenic, and chondrogenic media. The morphological characterization of induced cells was observed by microscopy and histological staining. The expression of marker genes was measured by RT-PCR. Results The endogenous GFP and multilineage potential of transgenic DPSCs had no influence on each other. Moreover, the results of fluorescence microscopic imaging suggest that there was no significant decline of GFP expression during DPSCs differentiation. Conclusion As the population of GFP labeled DPSCs can be easily identified, this will be a promising method for tracking DPSCs in vivo.

DAPT Enhances the Apoptosis of Human Tongue Carcinoma Cells

Aim To investigate the effect of DAPT （γ-secretase inhibitor） on the growth of human tongue carcinoma cells and to determine the molecular mechanism to enable the potential application of DAPT to the treatment of tongue carcinoma. Methodology Human tongue carcinoma Tca8113 cells were cultured with DAPT. Cell growth was determined using Indigotic Reduction method. The cell cycle and apoptosis were analyzed by flow cytometry. Real-time PCR and Immuno-Fluorescence （IF） were employed to determine the intracellular expression levels. Results DAPT inhibited the growth of human tongue carcinoma Tca8113 cells by inducing G0-G1 cell cycle arrest and apoptosis, The mRNA levels of Hairy/Enhancer of Split-1 （Hes-1）, a target of Notch activation, were reduced by DAPT in a dose-dependent manner. Coincident with this observation, DAPT induced a dose-dependent promotion of constitutive Caspase-3 in Tca8113 cells. Conclusion DAPT may have a therapeutic value for human tongue carcinoma. Moreover, the effects of DAPT in tumor inhibition may arise partly via the modulation of Notch- 1 and Caspase-3.

Ponseti method compared with soft-tissue release for the management of clubfoot:A meta-analysis study

AIM: To compare the functional outcomes of patients who underwent open surgery vs Ponseti method for the management of idiopathic clubfoot and to determine whether correlations exist between functional outcome and radiographic measurements.METHODS: A meta-analysis of the literature was conducted for studies concerning primary treatment of patients with idiopathic clubfoot. We searched PubM ed Medline, EMBASE, and the Cochrane Library databases from January 1950 to October 2011. Meta-analyses were performed on outcomes from 12 studies. Pooled means, SDs, and sample sizes were either identified in the results or calculated based on the results of each study.RESULTS: Overall, 835 treated idiopathic clubfeet in 516 patients were reviewed. The average follow-up was 15.7 years. Patients managed with Ponseti method did have a higher rate of excellent or good outcome than patients treated with open surgery(0.76 and 0.62, respectively), but not quite to the point of statistical significance(Q = 3.73, P = 0.053). Age at surgery wasnot correlated with the functional outcome for the surgically treated patients(r =-0.32, P = 0.68). A larger anteroposterior talocalcaneal angle was correlated with a higher rate of excellent or good outcomes(r = 0.80, P = 0.006). There were no other significant correlations between the functional and radiographic outcomes.CONCLUSION: The Ponseti method should be considered the initial treatment of idiopathic clubfeet, and open surgery should be reserved for clubfeet that cannot be completely corrected.

Comparison of Effects of Mechanical Stretching on Osteogenic Potential of ASCs and BMSCs

Mechanical forces play critical roles in the development and remodeling processes of bone. As an alternative cell source for bone engineering, adipose-derived stem cells （ASCs） should be fully investigated for their responses to mechanical stress. Similarly, the osteogenic potential, stimulated by mechanical stress, should be compared with bone marrow stromal cells （BMSCs）, which have been clinically used for bone tissue engineering. In this study, ASCs and BMSCs were osteogenic-induced for 48 hours, and then subjected to uniaxial mechanical stretching for 2 or 6 hours. Cell orientation, osteogenic regulatory genes, osteogenic genes and ALP activities were measured and compared between ASCs and BMSCs. ASCs could align in a perpendicular way to the direction of stretching stress, while BMSCs did not present a specific alignment. Both 2 and 6 hours mechanical stretching could enhance the mRNA expression of Osx and Runx2 in BMSCs and ASCs, while OCN mRNA only increased in ASCs after 6 hours mechanical loading. Mechanical stretching enhanced the BMP-2 mRNA expression in ASCs, while only after 6 hours of mechanical loading significantly increased the BMP-2 gene expression in BMSCs. Significant differences only exist between ASCs and BMSCs loaded at 2 hours of mechanical stretching. It is concluded that ASCs are more rapid responders to mechanical stress, and have greater potential than BMSCs in osteogenesis when stimulated by mechanical stretching, indicating their usefulness for bone study in a rat model.

Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic(CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-toend anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions.

Correction of scoliosis by three-dimensional instrumentation

AIM: To observe the clinical effects of three-dimensional instrumentation in the correction of frontal, sagittal and axial plane deformity of scolio-sis. METHODS: From June 1996 to June 2001, 52 cases of scoliosis were corrected with three-dimensional instrumentation. Among them, 36 cases were treated with CD system, 5 cases were treated with TSRH, 6 cases were treated with China Greatwall and 5 cases were treated with Scofix. RESULTS: All the patients were followed-up for an average of 2 years (ranging from 1 to 4 years). The averaged frontal curve was 25. 5°(ranging from 10°to 46°), the average correction rate was 63. 6%. The average sagittal curve was 27°(ranging from 20°to 35°) . CONCLUSION: Three-dimensional instrumentation is effective in three-dimensional correction and is an excellent tool for scolioeis correction. The fixation is reliable and the complications rarely occurred.

Current concepts in end-to-side neurorrhaphy

In peripheral nerve injury,end-to-side neurorrhaphy involves coaptation of the distal stump of a transected nerve to the trunk of an adjacent donor nerve.It has been proposed as an alternative technique when the proximal stump of an injured nerve is unavailable or the nerve gap is too long to be bridged by a nerve graft.Experimental and clinical data suggests that end-to-side neurorrhaphy can provide satisfactory functional recovery for the recipient nerve,without any deterioration of the donor nerve function.The most accepted mechanism of nerve regeneration following end-to-side neurorrhaphy is collateral sprouting.The source of the regenerating axons traveling in the epineurium of the donor nerve is thought to be the proximal Ranvier’s nodes at the site of end-to-side neurorrhaphy,however,histologic evidence is still lacking.Partial neurotomy of the donor nerve may enhance regeneration of motor neurons through end-to-side neurorrhaphy and reinnervation of motor targets.

Monteggia type-Ⅰequivalent fracture in a fourteen-month-old child:A case report

BACKGROUND Monteggia and equivalent lesions are relatively rare but result in severe injuries in childhood,typically affecting children between 4 and 10 years old.The diagnosis and treatment of an equivalent Monteggia lesion is more complicated than those of a typical Monteggia fracture.This type of lesion may be challenging and may lead to serious complications if not treated properly.Pediatric Monteggia equivalent type I lesions have been reported in a few reports,all of which the patients were all over 4 years old.CASE SUMMARY A 14-mo-old boy was referred to our clinic after falling from his bed 10 d prior.With regard to the clinical examination,an obvious swollen and angular deformity was noted on his right forearm.Plain radiographs and reconstructed computed tomography scans showed a Monteggia type I fracture and dislocation.Magnetic resonance imaging(MRI)confirmed a type I Monteggia equivalent lesion consisting of ulnar fracture and Salter-Harris type I injury in the proximal radius.The radial head was still in the joint,and only the radial metaphysis was displaced anteriorly.Open reduction and pinning of both displaced radial and ulnar fractures achieved an excellent result with full function.CONCLUSION We recommend MRI examination or arthrography during reduction,especially if the secondary ossification center has not appeared.

Guidelines for management of pediatric acute hyperextension spinal cord injury

Pediatric acute hyperextension spinal cord injury(SCI)named as PAHSCI by us,is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training,which has been increasingly reported.At present,it has become the leading cause of SCI in children,and brings a heavy social and economic burden.Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards,specifications or guidelines.In order to provide standardized guidance,the expert team formulated this guideline based on the principles of science and practicability,starting from the diagnosis,differential diagnosis,etiology,admission evaluation,treatment,complications and prevention.This guideline puts forward 23 recommendations for 14 related issues.

Magnetically controlled growing instrumentation for early onset scoliosis: Caution needed when interpreting the literature

BACKGROUND Magnetically controlled growing rods(MCGR) are a novel treatment option for early onset scoliosis(EOS). Although the complication profile with MCGR use has been reviewed, these reviews do not take into account important implants modifications, termed iterations, that were made due to early on postoperative complications is not well reported or understood.AIM To assess the effect of MCGR implant iterations on post-operative complications in EOS.METHODS A systematic review was performed to identify studies investigating MCGR specifically for the treatment of EOS, refined to those reporting the implant iteration, specifically the incorporation of the keeper plate to the implant design.Articles with mixed implant iteration usage were excluded. Complications following surgery were recorded as well as potential risk factors and compared between implant cohorts.RESULTS Although 20 articles were identified for inclusion, 5 included mixed implant iteration leaving a total of 271 patients identified through 15 clinical studies thatmet inclusion criteria. The average follow-up was 25.4-mo. Pre-keeper plate implants were utilized in 3 studies with a total of 49 patients. Overall, 115(42.4%)post-operative complications were identified, with 87% defined as major. The addition of the keeper plate significantly decreased the rate of post-operative complications per study(35.7% vs 80.6%, P = 0.036), and the rate of distraction failure(8.1% vs 40.8%, P = 0.02). Unplanned reoperation occurred in 69(26.7%)patients but was not different between implant iteration cohorts(25.5% without keeper plate vs 27.1% with keeper plate, P = 0.92).CONCLUSION MCGR for EOS has a cumulative complication rate of 42.4% but this is significantly reduced to 35.7% when reviewing only keeper-plate enabled implants. However, 25% of published articles included mixed implant iterations.Future studies should discern between implants iterations when reporting on the usage of MCGR for EOS.

CONGENITAL DISLOCATION OF THE HIP AND JOINT LAXITY

The authors reviewed 200 normal children and 225 cases of congenitaldislocation of the hip (CDH), all below 5 years of age. These cases were checked at thehip, ankle, elbow, wrist and knee for hyper-extension and thumb-radius angle at the wrist.From the values of 200 normal cases, SD was derived. Joint laxity was graded by the fol-lowing method (Wynne Davies, Tsuyama). SD±2=2 points, SD±1=1 point,【SD=0point. The result showed that in the normal group there were 8-12% of joint laxity,whereas in the CDH group there were 34-46%. Dividing the CDH and normal groups in-to boys and girls, and those below 2 and those aged 2-5 years group (50 each), itshowed a P value of 【0.01, 【0.02, 【0.01 and 【0.001 respectively. The authors believedthat CDH has a congenital fibrous tissue defect, probably associated with abnormality ofthe collagen fibres. The authors discuss this with clinical problems.

Length unstable femoral fractures:A misnomer?

BACKGROUND Flexible intramedullary nailing(FIMN)is relatively contraindicated for pediatric length unstable femoral fractures.AIM To evaluate FIMN treatment outcomes for pediatric diaphyseal length unstable femoral fractures in patients aged 5 to 13 years.METHODS This retrospective study includes pediatric patients(age range 5-13 years)who received operative treatment for a diaphyseal femoral fracture at a single institution between 2013 and 2019.Length unstable femur fractures treated with FIMN were compared to treatment with other fixation methods[locked intramedullary nailing(IMN),submuscular plating(SMP),and external fixation]and to length stable fractures treated with FIMN.Exclusion criteria included patients who had an underlying predisposition for fractures(e.g.,pathologic fractures or osteogenesis imperfecta),polytrauma necessitating intensive care unit care and/or extensive management of other injuries,incomplete records,or no follow-up visits.Patients who had a length stable femoral fracture treated with modalities other than FIMN were excluded as well.RESULTS Ninety-five fractures from ninety-two patients were included in the study and consists of three groups.These three groups are length unstable fractures treated with FIMN(n=21),length stable fractures treated with FIMN(n=45),and length unstable fractures treated with either locked IMN,SMP,or external fixator(n=29).P values<0.05 were considered statistically significant.Patient characteristic differences that were statistically significant between the groups,length unstable with FIMN and length unstable with locked IMN,SMP,or external fixator,were average age(7.4 years vs 9.3 years,respectively),estimated blood loss(29.2 mL vs 98 mL,respectively)and body mass(27.8 kg vs 35.1 kg,respectively).All other patient characteristic differences were statistically insignificant.Regarding complications,length unstable with FIMN had 9 total complications while length unstable with locked IMN,SMP,or external fixator had 10.Grouping these complications into minor or major,length unstable with locked IMN,SMP,or external fixator had 6 major complication while length unstable with FIMN had 0 major complications.This difference in major complications was statistically significant.Lastly,when comparing patient characteristics between the groups,length unstable with FIMN and length stable with FIMN,all characteristics were statistically similar except time to weight bearing(39 d vs 29 d respectively).When analyzing complication differences between these two groups(9 total complications,0 major vs 20 total complications,4 major),the complication rates were considered statistically similar.CONCLUSION FIMN is effective for length unstable fractures,having a low rate of complications.FIMN is a suitable option for length stable and length unstable femur fractures alike.

Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease:A database study

BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting.Two recent examples include slipped capital femoral epiphysis(SCFE)and Blount’s disease.Surgical indications are well-studied for each pathology,but to our knowledge,there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition.We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics,rates of complications,and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.RESULTS Total 1788 SCFE database entries were included,30%were performed in an outpatient setting.In situ pinning was used in 98.5%of outpatient surgeries and 87.8%of inpatient surgeries(P<0.0001).Inpatients had a greater percent of total complications than outpatients 2.57%and 1.65%respectively.Regarding Blount’s disease,outpatient surgeries constituted 41.2%of the 189 procedures included in our study.The majority of inpatients were treated with a tibial osteotomy,while the majority of outpatients had a physeal arrest(P<0.0001).Complications were encountered in 7.4%of patients,with superficial surgical site infections and wound dehiscence being the most common.1.6%of patients had a readmission.No differences in complication and readmission risks were found between inpatients and outpatients.CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting.This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions.Osteotomies are more commonly performed in an inpatient setting where monitoring is available.

Effectiveness of psychosocial interventions for pediatric patients with scoliosis:a systematic review

Background Pediatric patients affected by scoliosis have complex psychological and social care needs,and may benefit from psychosocial interventions.We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population.Methods Literature was identified by searching Medline,PsycINFO,Embase,EBSCO Cumulated Index to Nursing and Allied Health Literature(CINAHL),and Cochrane Central Register of Controlled Trials(CENTRAL)from database inception to 20 March 2022.Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included.Article eligibility,data extraction,and quality assessment(using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies)were performed by two independent researchers.Findings are presented using narrative synthesis.Results We identified ten studies,all of which focused on adolescent idiopathic scoliosis.Studies included a total of 1007 participants,most of whom were female.Three studies focused on patients undergoing bracing,six on patients undergoing spinal surgery,and one on patients broadly.Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity.Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes.Several studies examined the efficacy of brief educational interventions;most did not report clear evidence of their efficacy.The methodological quality of studies was often unclear due to limitations in articles'reporting quality.Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited,with interventions involving frequent patient-provider interactions showing the most promise.Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population,with emphasis on multidisciplinary teams delivering holistic care.

Hippo signaling activates hedgehog signaling by Taz-driven Gli3 processing

The overlapping roles of Hippo and Hedgehog signaling in biological functions and diseases prompt us to inves-tigate their potential interactions.Activation of Hippo signaling enhances the transcriptional output of Hedgehog signaling,and the role of Hippo signaling in regulating Hedgehog signaling relies on the Hippo pathway key effector,Taz.Interestingly,Taz exhibits a gradient expression across the posterior-to-anterior of limb bud mesoderms,similar to Sonic hedgehog(Shh).Importantly,Taz drives PKA to phosphorylate Gli3,resulting in the Gli3 processing into its repressor and attenuation of Hedgehog signaling in the Shh-independent manner.Specifically,Taz deletion in mouse embryonic limb bud mesenchyme not only enhances the Hedgehog signaling but partially restores the phenotypes from Shh deletion in causing severe defects of anteroposterior patterning and digit number and identity.Together,these results uncover Taz-dependent Gli3 processing as a hitherto uncharacterized mechanism controlling Hedgehog signaling,highlighting its cross-regulation by Hippo signaling.